EFFECT OF LISINOPRIL ON 24-HOUR BLOOD PRESSURE AND ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION AND RHEUMATOID ARTHRITIS

Aim. To study effect of 24-week treatment with lisinopril on blood pressure (BP) and arterial stiffness in patients with arterial hypertension (HT) and rheumatoid arthritis (RA). Material and methods. Twenty patients with essential HT grade  1-2 and RA (mean age 60.2±7.9 years) were treated with lisinoprilin 24 weeks in open controlled study. Office blood pressure (BP) was 147.2±9.4/87.5±8.6 mm Hg; 24-h mean  BP – 141.8±9.3/82.2±9.6 mm Hg; HT duration was 14.5±9.4 years, and RA duration – 12.3±2.6 years. A high incidence of traditional cardiovascular risk factors was identified: 95% of patients had dyslipidaemia, 45% – obesity, 35% – impaired glucose tolerance. Atherosclerosis of carotid arteries with stenosis less than 25% was diagnosed in 65% of patients. Most patients had a positive rheumatoid factor and cyclic citrullinated peptide antibodies, as well as moderate RA activity and III-IV radiologic stage of RA. All patients received methotrexate as the basic anti-inflammatory drug, 12 (60%) patients – selective cyclooxygenase-2 inhibitors, 6 (30%) patients took corticosteroids equivalent to prednisolone 7.5±5.5 mg per day. Mean  dose  of lisinopril was 12.2±9.8 mg/day. Office BP measurements, 24-hour ambulatory BP monitoring (ABPM), and  arterial stiffness evaluation were  performed initially and  at the end of the study. Arterial stiffness was assessed by cardio-ankle vascular index on the right (R-CAVI) and on the left (L-CAVI). Results. After 24-week therapy with lisinopril office systolic and diastolic BP significantly decreased by 16.0±7.2/11.6±9.1 mm Hg (p<0.0001) and 11.6±9.1 mm Hg (p<0.0001), respectively. The target BP was achieved in 16 (83%) patients. According to the ABPM 24-week therapy with lisino pril led to a significant (p<0.002) decrease in BP for all referable periods: by 12.4±9.1/7.6±3.9 mm Hg within 24 hours;  by 13.4±10.1/8.0±6.1 mm Hg for daytime; by 10.1±9.3/7.3±6.3 mm Hg for night-time. After lisinopril treatment, R-CAVI decreased from 8.9±1.7 to 8.4±1.6 relative units (p=0.011), L-CAVI decreased from 8.9±1.6 to 8.4±1.5 relative units (p=0.003). Conclusion. In patients with combination of HT and RA, 24-week therapy with lisinopril had a significant antihypertensive effect and improved the elastic properties of the vessels.